Are virtual consultations both practical and safe?

The NHS’s new plan promises that ‘over the next five years, every patient will have the right to online digital GP consultations, and that redesigned hospital support will mean up to a third of outpatient appointments will be unnecessary, saving patients 30 million trips to hospital, and saving the health service over £1 billion a year in new expenditure.’

The amount of people using digital services for medical appointments is at its highest yet. Recent figures from NHS Digital show that almost a quarter of patients (14.3 million people) used GP online services to make appointments, view test results and order repeat prescriptions. 

But clinicians – both GPs and hospital doctors – are currently untrained in the art of virtual consultations and many doctors have misgivings about making important clinical decisions about patients without the possibility of performing a physical examination. What are the medico-legal implications if an incorrect diagnosis is arrived at following an e-consultation and the patient suffers harm as a result? Online ‘digital’ consultations certainly have the potential to save money but how well will they work in practice and what retraining will be required?

What are your thoughts and experiences? Have digital consultations already made their presence felt in your practice? Let us have your views by adding a comment to this blog.

Comments (2) Add yours ↓
  1. Nitin Shrotri Consultant Urologist

    It’s definitely worth a try. It is likely to mean slightly more work for the doctor as communication is less than ideal with the accompanying inability to carry out a physical examination. As long as confidentiality can be maintained, for the patient, it could mean a massive advantage in terms of saving their own and relatives travel time, parking charges, contrasted by the lack of an ever decreasing social interaction for the housebound. Payments for the hospital should not be slashed because of use of this mode of clinic attendance. All in all, a good thing, which has been a long time coming.

    January 11, 2019 Reply
  2. Mike Flannigan Retired Urologist

    Dear Roger

    Virtual medicine is essential for the future of any health service. We should embrace it and develop it to maximise the quality of care for everyone and to reduce the crippling costs of modern healthcare.

    It must include video, face to face consultation. We cannot ignore the value of body language in assisting our diagnosis. The patients also have more faith in the consultation when seeing the person offering the advice and help.

    It is only possible because of the introduction of appraisal and revalidation which both ensure the individual healthcare worker is not over-burdened with work, either through his own desire or that of managers, and, anyone offering services is adequately trained for the work.

    Virtual healthcare can be offered at a number of levels:

    1. Outpatients
    2. Emergency Consultations
    3. Interdepartmental Consultations
    4. National and International Consultations

    Healthcare workers can make themselves available;

    1. For regular sessions each week
    2. Randomly during ‘down time’ when not in the main institution
    3. While involved in other activities ie at appropriate times during operating lists, standard outpatient clinics or ward rounds.
    4. In the new world of older retirement ages then ‘on site’ hours can be reduced and ‘at home’ hours used to continue to offer a service.
    5. Where early retirement through illness occurs. The individual can continue to offer a service as long as appraisal identifies no impairment of quality and revalidation confirms adequacy of knowledge.

    Medical indemnity has to be considered and the various Defence Unions will need to address this carefully. Crown indemnity for NHS consultations may also restrict practice or impose specific constraints.

    Medico-legal concerns can be avoided by the use of recording of all consultations. When I investigated the introduction of virtual medicine 10-15 years ago one the first steps we took was to find a digital storage device, with NHS level encryption, which could store 20years of video data.

    This has additional advantages as the medical personnel and patients can be given access to the discussions for reference but also for teaching. With appropriate feedback from students and trainees gold standard teaching sessions for all conditions would quickly become obvious.

    There is no doubt the introduction of such systems leave us all open to more severe scrutiny. The converse obtains, however, where we only offer services in which we are absolute experts.

    I was initially encourage examine virtual medicine when Tony Blair announced in 2002 that by 2004 all homes in the country would have access to fast broadband through their television sets. Sadly we are not there yet.

    My efforts floundered 10-15 years ago because of a lack of demand and concerns over such a critical change in practice. However, one of my colleagues, Tariq Shah, has set up such a system to bring access to high quality healthcare to remote parts of Pakistan. He can sit at home in Bradford, discuss symptoms with patients in Pakistan and advise less experienced healthcare workers, on the ground, how to triage the problems and develop appropriate and rapid diagnosis without the patients having to travel long distances.

    I am taking care not to enumerate the opportunities to save money as this will cause many readers to be concerned that they will lose the ‘family silver’. But when I tried to cost this out 12 years ago I anticipated savings of 25 billion pounds per year, for the NHS, and a significant increase in staffing levels by allowing retired and physically unfit healthcare workers to continue to contribute.

    In short, virtual medicine allows more rapid, more appropriate, more cost effective healthcare across the globe.

    January 11, 2019 Reply

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